Tag Archives: green paper

For all Andy Burnham’s fine words about following in the footsteps of Bevan and establishing a National Care Service, the White Paper – Building the National Care Service – doesn’t address the main problem with social care – and the original purpose of the green paper last year: how it is paid for.

But first, the good points:

The proposals for a National Care Service – free at the point of use, given according to need, with the principles of being universally accessible, having a strong national framework locally delivered, being preventative and flexible, with support for carers, and information and advice for all – is admirable.

Social care has – as the government admits – lagged behind other sectors, such as healthcare in terms of provision. It has never had a national structure and one is well overdue. It is hard to argue with the government’s aims here.

The commitment to put in place nationally consistent eligibility criteria for social care – enshrined in law – is one that many have been crying out for. The ending of the postcode lottery will go some way to addressing the perceived unfairness of the current system.

Likewise, ensuring accurate, relevant and accessible information about what people are entitled to, how the assessment process works and how to access care services is provided to everyone, and improving the gateway for accessing social care and disability benefits to make it simpler and easier for people, are also welcome and long-overdue developments.

Keeping Attendance Allowance and Disability Living Allowance also shows that the government has listened to some outcomes from the Big Care Debate – getting rid of this would have proved very unpopular.

The continuing commitment to the personalisation agenda – in giving service users choice and control – will also be welcomed by the majority, not least social workers who may have feared yet more upheaval.

But on the downside…

It also talks about people in residential care only having to pay their own fees for 2 years. Fine, but the average time spent by an older person in residential care is 3 years, so they would only get one year ‘free’.

Also, while people in residential care would still have to pay their accommodation costs, there is a commitment that no-one will have to sell their house to pay for care within their lifetime. With a deferred payment plan, their family may have to pay for it out of their estate after their death.

This leads neatly to the crucial bit – and one I suspect made with an eye on the election – no decision on the funding of the National Care Service will be made until 2015 at the earliest. Not so much kicking it into the long grass but the jungle.

This is where the White Paper falls down. The social care sector has been creaking along with the much-hated means testing system for years. It is widely accepted that the system needs reform – mostly because it is too complicated and perceived as unfair in some cases – and while it says it will address this, it doesn’t say how.

The government still leans towards some sort of compulsory levy – which means the so-called “Death Tax” isn’t dead – but is not specific on what. Indeed, they have called for a new commission to look at when and how the fee should be applied, and how much it should be. But wasn’t that the original aim of last year’s green paper?

However, in fairness, there wasn’t a great deal consensus on funding. Andy Burnham revealed that, of the 3 funding options outlined in the green paper, 35% favoured a partnership approach, 22% opted for an insurance model, while 41% backed the comprehensive approach.

Meanwhile, the Conservatives are still talking about their £8,000 voluntary insurance scheme to pay for all this. As mentioned before, this doesn’t seem to be enough and I doubt enough people will sign up to it, knowing it is something they may not need in the future.

So, much-needed reform is on the way for the social care sector. While the proposals are great in principle, I can’t help but worry how all this will be paid for – there is precious little on that.

Also, the lack of political consensus on this – the Tories branded the White Paper a ‘train crash’ in today’s Daily Mail – means that after an election we could be back to square one again.

So, Conservative shadow health secretary Andrew Lansley has pointed out that the government’s plans for funding residential care doesn’t include the ‘hotel’ costs of it.

For those of us that have followed this closely, this is not a revelation. This debate is about paying for care – board and lodging doesn’t come into it. When the green paper on adult social care funding was released last June, some people in social care pointed out that the proposals wouldn’t mark the end of people having to sell their house to pay for care. Interestingly, at the time, this was largely ignored.

Even in Scotland people in residential care have to pay ‘hotel’ costs – something which isn’t pointed out as often as it should be when people in England moan about ‘free’ care north of the border – and older people do still in some cases have to sell their house to pay for it.

But with the government set to shelve plans for the “Death Tax” this week, according to the Guardian, this seems to be the latest attempt to derail plans for reform.

Again, Lansley seems to be at the heart of this. While this smacks of another attempt at cheap political points-scoring ahead of the looming election, it does raise (albeit in a not-too-helpful way) a legitimate point.

One of the aims of any reform of adult social care funding, according to government messages when the green paper came out, is to eliminate people having to sell their homes. The options listed in the paper didn’t seem to do that.

It is still a problem – many voters see the practice as unfair and penalising those who have worked to own their own homes and leave an inheritance – and if it isn’t addressed many will see any white paper as a failure.

However, the green paper was only a consultation, and the white paper – apparently coming this week – may have a solution. We shall wait and see – and expect Labour’s opponents to seize upon it if it doesn’t.

As the debate continues over the announcement in yesterday’s Queen’s Speech of plans for free personal care at home for those in most need, what it does highlight is a lack of political consensus over the future of social care.

Leaving aside the debates on whether the announcement was just electioneering or if the government’s got its sums right with the £670 million per year cost, the hammering it got from the other main political parties’ shows that all have different ideas about the future of social care.

Labour has pinned its hopes on a National Care Service, which yesterday’s announcement is a trailer for and has been covered in the recent green paper.

Meanwhile, the Conservatives have mostly criticised Labour’s plans, while their own proposals have been relatively thin on the ground. The main one has been the idea of the insurance scheme, where people would pay £8,000 and then get free personal care as and when they need it.

As for the Liberal Democrats, they have advocated greater integration of health and social care, and that care be provided on the basis of need rather than ability to pay, but nothing much else recently.

It is widely accepted that social care needs overhauling but surely on something as big as this, and that affects so many people, the parties should be working together on it.

After all, service users and social care professionals surely want to know that policies will be consistent and not changed every time a new government is elected – that can be as harmful as doing nothing.

Finding a way forward is difficult – the debates over the green paper demonstrate this – but this should surely rise above the usual politicking for the good of the millions of service users and carers out there. It should, but I doubt it will.

It has emerged that the government will now not be releasing figures on how much each of its 3 options in its green paper on the future of adult social care funding will cost before the consultation closes next week.

Despite promises to the contrary, the figures, which would set out the costs and benefits of each option to the individual and the taxpayer, will not be out until next year.

The cynic in me thinks the delay says that the figures do not make good reading politically. Although, in fairness, it could be down to changes in policy since it was announced, such as Gordon Brown’s pledge to provide free home care to all those with critical needs.

But what it does mean – something that charities such as Counsel & Care have also pointed out – is that it makes deciding which of Labour’s options is best more difficult.

Given that some commentators have said that the future of adult social care rests on this decision – it is certainly one of the biggest decisions to be made in recent times – the pressure to get it right has just intensified for those taking part.